Excellent Editorial: Wichita Eagle

Medicaid plan unsettling for developmentally disabled
Rhonda Holman, Wichita Eagle editorial board


"The Brownback administration’s sweeping overhaul of Medicaid into a privately run managed-care system called KanCare mustn’t sweep individuals with developmental disabilities over the edge. As it is, there is a good argument for exempting the vulnerable population from such a sea change.

A packed weekend meeting in Wichita demonstrated how unsettling the governor’s plan is proving for the developmental disability community, as Department of Aging Secretary Shawn Sullivan was questioned about why the reform was needed and how it would affect loved ones.

Sullivan argues that care coordination is justified because many who are developmentally disabled suffer from medical conditions such as diabetes and high cholesterol, and have problems with mental illness and substance abuse. He makes a good point.

But families and providers are skeptical about the administration’s claims about KanCare, which will be managed by three for-profit insurance companies beginning Jan. 1, 2013 – including that services and reimbursement rates won’t be cut, that case managers needn’t change, and that current providers will be offered a place in the new system.

If such key elements won’t change, they understandably wonder, then how can dollars be saved, how can services and outcomes be improved, and why change the system at all?

It’s a further concern that only four states include long-term care for those with developmental disabilities in a Medicaid managed-care system, and that of those four, none looks like what is being proposed in Kansas, according to Matt Fletcher, associate executive director of the Topeka-based advocacy group InterHab. Moving Medicaid to managed care “can be done without having to include long-term care services,” Fletcher said at Saturday’s meeting.

The administration also didn’t help itself by crafting the reform with little stakeholder input, and by failing to get its answers straight since the plan’s November rollout. If the administration used a “very robust process” for getting input, as Mark Dugan, chief of staff for Lt. Gov. Jeff Colyer, told the crowd Saturday, it somehow was invisible to the developmental disability community.

Plus, the insurance companies interested in meeting the state’s Jan. 31 deadline for KanCare bids don’t seem to know much about serving those with developmental disabilities. And though Medicaid is costing the state too much overall, services for developmental disabilities are chronically underfunded, with a waiting list of 4,800.

Gov. Sam Brownback and Colyer are justified in trying to find a way to better coordinate care and curb Medicaid’s costs, which have grown at an average annual rate of 7.4 percent over the past decade.

But legislators need to continue to seek answers and reassurance from administration officials, including in a Senate Ways and Means Committee hearing today.

Kansas should think twice before it includes individuals with development disabilities in its managed-care experiment."